Video Welcome and Introduction Play Pause Volume Quality 1080P Fullscreen Captions Transcript Chapters Slides Welcome and Introduction Overview CLICK HERE FOR CME CREDIT Back to Symposium Welcome, welcome everybody to this symposium which is entitled Pushing the Limits of What Sensing Can Do for Type 1 and Type 2 diabetes. This is a CME certified symposium which is jointly provided by UMass Chan Medical School and the CME Educational Resources. Supported by an educational grant from ABBA Diabetes Care, and I'm, I am Stefano Del Prato. I'm a professor emeritus of endocrinology at the University of Pisa and I have the great honor and pleasure to chair this, uh, uh, symposium. Now, uh, before we start, I needed to, uh, show you my disclosure which I've shown here, but let me just, you know, try to introduce what we're going to discuss with our faculty, uh, today. Now there has been quite a lot of experience that's been matured over the past few years in terms of the use of CGM monitoring in people with diabetes. This is just, you know, interrogating the PubMed, as you can see here in the past 10 years or so, there's been a steady increase in the publication related to the use of CGM in the diabetes. And actually this is why we have been collecting evidence that really supports current recommendation for the use of CGM in diabetes, as has been the case of the most recent standard of care of the American Diabetes Association. Here is an example of what is being recommended. And the recommendation is that the use of CGM should be used in all people with diabetes on insulin therapy as well as in people on non-insulin therapies that may cause hypoglycemia, and it should be considered for any treatment where CGM may help in managing the disease. So it is really a recommendation that we are looking at, and this is because, as I said, it's based on evidence that has been collected over the time. And this is an exercise that has been done recently in my country in Italy by a good friend of mine, Andrea Jacquiri, where they've been evaluating all the current evidence for type 2 diabetes and the use of CGM. And you can see here the meta-analysis and the result of the meta-analysis. We're referring to people that are being treated with insulin and having type 2 diabetes, and you can see on the top the A1C, the timing range in the middle, and the tiny range in the bottom. And just to make a long story short, you can appreciate. In terms of each one of these glucose parameters, A1C, timing range, and time below range, there is an improvement. There is a reduction in A1C, an increase in timing range, and a reduction in the time below range. This is expected for people on insulin treatment, but what has been done here was also to analyze data that are available for people with type 2 diabetes who are not treated with insulin. And again, you cannot perceive that in these people and actually to an extent which is very similar to the one that has been reported in people treated with. You can still see a significant reduction in A1C, an increase in time and range, although there was no difference in time below range, but that's simply because most of these people have been treated with with the glucose lowering agents that are not associated with the risk of hypoglycemia. So it was the recommendation, the conclusion of this Italian group that are that were writing the Italian guidelines that there is support for a more widespread use of CGM in type 2 diabetes, although they also recognize that. We probably need to collect more data in terms of what is the potential effect in terms of the complication in these individuals, although we are gathering some information not only in terms of improvement in glycemic control but also in terms of reducing the risk of complication. This is a recent data. Uh, that has been, uh, reported, uh, looking at people, quite a large number of people you can see here using or not using CGM, and what has been even looked at, looked at here is the survival probability and what's the mortality, and you can see here quite a strong signal for, uh, and a positive effect, a beneficial effect of the use of CGM in terms of the mortality. So more information needs to be collected, but the science or the, the, the current available evidence points into the right direction. And because of all this information, is also the ASD, the, the AASD, uh, um, uh, consensus on the treatment of type 2 diabetes, which is going to be presented here in its final version, uh, it's a recommending, uh, use of technologies in. People with type 2 diabetes, definitely for those who don't insulin, but also for people not necessarily on insulin, but especially on those on insulin and even more, I think that CGM should be considered for the use of starting insulin at the right time. Now we are in the field of type 2 diabetes, we have very effective glucose lowering drugs, but insulin remains a keystone in the treatment of type 2 diabetes because there is still a large number of individuals that in spite of all the novel glucose lowering therapies that we may be using, still will require insulin, and this insulin requirement sometimes is is. to a larger extent. Here is an example. This is a survey that includes more than 3000 people with type 2 diabetes who are insulin naive, and out of these people that would be requiring treatment, 30% of them declined insulin treatment, and only 38% of the decline has eventually started insulin. This translates into keeping people exposed to the risk of hyperglycemia, and the reason. For this delay and the reason for this uh uh concern in starting insulin is due to a number of reasons. You can see here the reasons that have been evaluated in a population of people with type 2 diabetes and the other usual one is the fear of hypoglycemia is the. About the body weight gain and so on and so forth, but it's not only the concern of the patients, it's actually the concern of the uh uh the healthcare providers as you can see here and you can also appreciate particularly if you look for instance here for the fear of hypoglycemia. That the, the, the, the proportion of a physician, uh uh of a of a care provider uh that are concerned about starting insulin is actually twice as much than the the the people with diabetes who are concerned. So it becomes important here to consider to which extent the CGM may help starting in a sufficient and safe manner insulin treatment in people with type 2 diabetes when they do require it, and it's because of that that a number of experts have been got together and have been providing some recommendation in this paper that has been just released, and I would like to invite you to consider that in case you may be interested. Of course, there is no doubt, because it's well accepted that CGM is a sort of mandatory in people with type 2 diabetes. This is just an example of the improvement in A1C that has been reported in long, large number of papers in people with the type 1 diabetes. And of course, the CGM becomes key uh in the automated uh uh uh insulin delivery. So, uh, this is really becoming, The key treatment for people with type 1 diabetes and the use of this novel way to monitor glucose in people with type 2 in type 1 diabetes has been associated with a significant improvement not just in terms of the amelioration of A1C but. Also in terms of reducing the risk of a complication. You can see here cardiovascular related hospitality, but also uh uh a condition of a severe hypoglycemia that has been abated by more than 50% or diabetic ketoacidosis, which has been reduced very much reduced. But got abolished. You can see there is still quite a sizeable number of people with type 2 diabetes that in spite of continuous glucose monitoring, do have ketoacidosis, and ketoacidosis still remains a problem in people with type 1 diabetes. It has been reported in this a large population of close to 50,000 people with type 1 diabetes showing that. Uh, ketosidosis is present, particularly, uh, in the early, uh, uh, ages. We don't feel much difference between male and female. Is a present independently of the duration of the diabetes, although there is a peak, uh, let's say in in in the average duration of the diabetes, and of course it's more associated with a poor glycemic control, although even for people very well controlled, there is still a risk for ketoacidosis. I think that in terms of improving the overall metabolic condition of people with type 1 diabetes, we need really to pay attention to glucose control as well as to avoiding the ketoacidosis, and this may become possible or maybe allow us to tackle that in a more effective manner by the. Use of the ketone body sensors that have been combined together with the glucose monitoring, which is a system that has been recently authorized by the FDA but even more recently also approved by the European, the European Agency of Medicine. So what we are facing in the next future, in the near future, is really how to improve the outcomes in people with The type 1 diabetes and with the type diabetes by combining the monitoring of ketones and glucose, and this is what we need to do is to push from continuous glucose monitoring of glucose uh into the future and this means uh identifying or tackling specific uh uh uh specific targets for instance, how we're gonna move from CGM to continuous dual sensing how the CGM may allow us to really establish. A more personalized treatment, how the CGM can be used for the optimization of complex treatments as they may occur in people with both type 1 and type 2 diabetes. And these are three points of moving forward that are going to be discussed in this symposium with the participation of Professor Christophe De Bloc, who is going to discuss beyond CGM dual sensing technology as the cornerstone for DKA prevention. Together with Professor Concetta Irace, who's going to discuss the foundation role of this IGM for personalized A1C optimization, and finally with Dr. Emma Wilson who's going to discuss with us CGM for type 2 diabetes in the setting of basal. and LGLT2 and GLP1 uh treatment and she's been reporting on the free uh uh DM2 uh study. So with any further ado, let's move on and I would like to invite now the first speaker, uh, and, uh, we will have discussion later on. Thank you very much. Published September 23, 2026 Created by Related Presenters Stefano Del Prato, MD President - Fondazione MenariniProfessor Emeritus of EndocrinologyUniversity of PisaPisa, Italy
